Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2014
Patient and procedural characteristics for successful and failed immediate tracheal extubation in the operating room following cardiac surgery in infancy.
Immediate extubation in the operating room after congenital heart surgery is practiced with rising frequency at many cardiac institutions to decrease costs and complications. Infants less than one year of age are also increasingly selected for this 'fast track'. However, factors for patient selection, success, or failure of this practice have not been well defined in this population, yet are critical for patient safety. ⋯ Extubation immediately after infant heart surgery in the operating room can be safely achieved. However, our data suggest that patients undergoing more complex procedures should be selected more conservatively for immediate early extubation.
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Paediatric anaesthesia · Aug 2014
Meta AnalysisIs dexmedetomidine superior to midazolam as a premedication in children? A meta-analysis of randomized controlled trials.
In the current published literature, there are controversial results regarding the effectiveness of dexmedetomidine compared with midazolam as premedication in children. The aim of this meta-analysis was to compare the use of dexmedetomidine as a premedication in pediatric patients with that of midazolam. ⋯ This meta-analysis demonstrated that dexmedetomidine premedication is superior to midazolam premedication in terms of producing satisfactory sedation upon parent separation and mask acceptance. Dexmedetomidine premedication provides clinical benefits that included reducing the requirements for rescue analgesia and reducing agitation or delirium and shivering during the postoperative period. However, the risks of heart rate and blood pressure decreases, and the prolonged onset of sedation associated with dexmedetomidine should be considered.